Abstract
Long-term antiretroviral therapy has modified the clinical course of HIV infection to a chronic condition associated with increased risk of developing non-communicable diseases (NCDs). Information is scant, from sub-Saharan Africa, on the prevalence of NCDs and associated factors among individuals on ART. We consecutively enrolled individuals with HIV infection who were ART naïve and those on ART for ≥5 years (LTART) attending health facilities in Dar es Salaam. Participant's blood pressure, anthropometric measurements, and fasting blood glucose were recorded. Participants with impaired fasting blood glucose underwent an oral glucose tolerance test. A venous blood sample was sent to the lab for biochemical tests. Chi-square test was used to compare proportions, Poisson regression with robust standard errors was used to determine associations between variables. Overall, 612 individuals with HIV infection were enrolled, half of whom were ART naïve. Females comprised 71.9% and 68.0% of participants in the LTART and ART naïve study arms, respectively, p = 0.290. The mean age (±SD) was 44.9 ± 12.7 years and 37.5 ± 11.8 years among LTART and ART naïve participants, respectively, p<0.001. Hypertension was documented in 25.2% in those on LTART compared to 6.9% among ART naïve subjects, p<0.001. Impaired glucose tolerance was found in 22.9% and 4.6% among LTART compared to ART naïve subjects, p<0.001. Diabetes mellitus was detected in 17.0% of those on LTART compared to 3.9% ART naïve participants, p<0.001. Hypercholesterolemia was found in 30.4% of individuals on LTART compared to 16.7% of ART naïve subjects, p<0.001, and hypertriglyceridemia was found in 16.0% of participants on LTART compared to 9.5% of ART naïve, p = 0.015. LTART use, age ≥40 years, history of smoking, and body mass index were independently associated with NCDs. Hypertension, impaired glucose tolerance, diabetes mellitus, hypercholesterolemia, and hypertriglyceridemia were associated with long-term use of antiretroviral drugs.
Highlights
HIV has affected parts of the world variably with sub-Saharan Africa having about two-thirds of the total number of people living with HIV (PLWHIV)
Hypertension was documented in 25.2% in those on long-term ART (LTART) compared to 6.9% among antiretroviral therapy (ART) naïve subjects, p
Impaired glucose tolerance was found in 22.9% and 4.6% among LTART compared to ART naïve subjects, p
Summary
HIV has affected parts of the world variably with sub-Saharan Africa having about two-thirds of the total number of people living with HIV (PLWHIV). Endothelial dysfunction, as well as metabolic disorders associated with HIV-related chronic inflammation and the use of antiretroviral drugs that cause toxicity through direct or indirect effects, may be responsible for the observed excess risk of NCDs [2,3]. With over 35 million people living and aging with HIV, a new global challenge of addressing morbidity and mortality due to NCDs in PLWHIV is looming [4]. NCDs tend to increase with age and are prevalent in PLWHIV where HIV disease and its treatment are being implicated in the causation. Long-term antiretroviral therapy has modified the clinical course of HIV infection to a chronic condition associated with increased risk of developing non-communicable diseases (NCDs). Information is scant, from sub-Saharan Africa, on the prevalence of NCDs and associated factors among individuals on ART
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